Coronavirus disease 2019 (COVID-19) is one of the largest public health pandemics since
the Spanish flu of1918. With a wide spectrum of clinical manifestations, COVID-19 has
caused major setbacks in healthcare worldwide and challenged the capabilities of some of
the most accomplished health care systems in the world. Although up to 80% of patients
are initially asymptomatic, a nonnegligible percentage eventually require hospitalization
and intensive care admission (ICU)Johns Hopkins,2020.Currently, the worst complication of
COVID-19 is vascular inflammation and degeneration, AbdelMassih AF, Kamel A et al. Most
children with COVID-19 present with a range of signs and symptoms that are not severe or
specific enough to prompt disease testing.3 Some children and adolescents show no
symptoms at all,Han MS, Choi EH, et al .The challenge with unrecognized COVID-19 cases is
that asymptomatic children might become silent carriers in the community, DeBiasi RL,
Delaney M,et al.or be at risk of developing post-COVID-19 complications. post-acute
COVID-19 includes patients with persistent or delayed symptoms that develop, or last,
more than 3 weeks after symptom-onset. The 3-week period is in line with evidence that
viable virus is rarely detected past 10 days in mild to moderate COVID-19, and rarely
past 20 days in severe cases, DeBiasi RL, Delaney M, et al. Another term used to describe
this condition is "long COVID". Butler M, Pollak TA, Baker HA,et al. Since MIS-C is not
true sequelae, we will report on MIS-C separately from post-acute COVID-19. MIS-C is a
newl recognized illness associated with severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection. McMurray et al. (2020) described MIS-C as a post-viral systemic
inflammatory vasculopathy of children following SARS-CoV-2 infection, with similar
clinical presentations to Kawasaki disease. Ontario Agency for Health Protection and
Promotion,2020. In April 2020, reports from the United Kingdom documented a clinical
presentation in children identical to Kawasaki disease (KD) or toxic shock syndrome.
Since then, there has been an increase in reported cases of similarly affected children
in other parts of the wothe, Riphagen S, Gomez X, et al ,2020. The cases have been
reported from Asia, North America, Latin America and Europe in the past 3 months,
describing children with COVID-19-associated multisystem inflammatory syndrome in
children (MIS-C), which is likely to develop after the disease instead of developing
during the acute phase of COVID-19 Jones VG, Mills M, et al, 2020.Thrombotic
complications have alsobeen reported in children with COVID-19, Mitchell W, Davilla J,
Whitworth H, Sartain SE,2020.